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FOROFFICE USE: --------------------------------------------------------- ---- ------------------------------------------------- ------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------------- ------------ (Complete in Duplicate) -.--" This Permit Expires 1 Year From Date Issued ALS 7 Date Issued .J-=_5 17,0-�y Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfaq the work herein described. This application is made in compliance with County Ordinance No. 549. f '71 ^� t7G S , A4T-- , S' JOB ADDRESS AND LOCAT 0------C��l� ----�-rl- ------ A C_F_N------_'�`-----TWO ��----- .�� •---- Owner's Name---------------1tl -11-i-1-i}m----------- > � -- ------------------- Phone------------------------------•--- -- --- -------- -------- - Address -` ___Alm ll-------------------------•-----------------------•------------ Contractor's Name_WARREa---- 5 -- ---------------- --------------- ------ Phone---------------------------- ------ Installation will serve: Residence �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living,units: j----- Number of bedrooms -3-- Number of baths _{--- Lot size - D---_" __________________ Water Supply: Public system ❑ Community system ❑ Private J2-"Depth to Water Table _C _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑' Sand•y-Loam a Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_________ __________l No4 New Construction: Yes ❑ No FHA/VA: Yes ❑ No [�— TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available,within 200 feet.) r Septic Tank: Distance from nearest well----"e_---Distance from foun4lation-_--"_"" "_ r�_"__"".M ter al..__��/10rC-}`�_� , Capacity--- No. of compartments---.. - Size_ 0( P --- - $/�10 _5---Liquid depth I Disposal Field: Distance from nearest well._ ..-"Distance from foundation----I.0-------.Distance to nearest lot line-----> ... [ � Number oflines----------------------------------Length of each line------------------------------Width of trench-------------_--------------------- Type of filter' material_______________________Depth of filter material-----------------------Total length _______-___."---___ .-----__-___-__-_-___ Seepage Pit: I Distance to nearest well ____ Distance from foundation--------------------Distance to nearest lot line_-_____-_-__---- lel ❑ Dumber of. ----------- .;Li ing material----- - - ------------Size: Diameter-----------------------Depth-----------------------------_--_ Cesspool: Distance from nearest --------Distance from foundation--------------------Lining material-_--_---_-__-_-_____---___________-_. Size: Diameter- ------------- --`- ...........Depth---------------- ------------ - ---------------Liquid Capacity ---- gals. Privy: r . Distance from nearest well;.-._nµ_ ----------------------------- _-_ _Distance from nearest building-_--_---_-_____________________-___._. ❑ Distance to nearest lot line-..------------------------------------ ----- -------------------'------------------ -----------------------------------------------------•- to Remodeling and/or repairing (describe}:---------RIrP - ---------L`-KI T1 -----------��-SNI---A---------------------------------- . ------------------------------•------------------------------ --- I hereby certify that I have re d this application and that the work will be done in accordance with San Joaquin County ordinances, St gp and rules regulations of th San Joaquin Local Health District. (Signed).-- ----- ------ -- ---------- ------(Owner and/or Contractor) r Bri ( ) _ ----- ----- -• - --- Title (Plot plan, showing size of lot, location of system.in-rela on to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---...- �--T �C�.�-,------_- -- -v DATE---------- �`_ 7_'_ -°--------------=- a3 ______________"__"__--__-___-_._ __ REVIEWED BY---------------------------------------- ----- - DATE-----.-. �- --- _. BUILD]NG PERMIT ISSUED ---------------------------------------- --------------------- ------r------------------ DATE------- ------------------------------------------- Alterations and/or recommendations:-------------- -------------------------------------------- -----------------i----------------•- ------------------------------- ------------------ ------ --------------------------------------------------- ----- - - ------ --- --- ------------------------------------------------------------------ ------- ----------- ------ -------------------------- FINAL INSPECTION BY- _ Date_______.._. f'/J-- �._ , 2 ----------- -- - --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 9 0� l160r Ef ♦ �� 300 West Ook'Street 124 Sycamore Street 205 West 9th Street { -- � Stockton,California I-ocli,California Manteca,California Tracy,California F.P.CC. iM'y